Drummond Report: Hospital amalgamations and more power for LHINs among recommendations

The prescription to fix Ontario’s health system may sound harsh — amalgamating hospitals, reducing the powers of doctors in policy decisions and empowering local health integration networks — but it may be necessary for patients, says the commission in charge of reforming public services.

Economist Don Drummond believes a 20-year plan — shepherded by a new health commission — is needed to achieve the 105 recommendations he says must happen to drive down out-of-control health spending costs.

“Everything needs to start with a clear road map,” Drummond said Wednesday.

Health-care spending is rising too fast and can’t continue this way, he said.

Ontario spent $44.8 billion on health in 2010-2011 and that is 40.3 per cent of its total spending on programs. Of that, operating hospitals accounted for 35 per cent of health care spending and 27 per cent went to doctors and practitioners.

If the pattern continues, Ontario’s health budget will rise to $62.5 billion by 2017-2018 for an average annual increase of 4.9 per cent from 2010. But it should be held at a 2.5 per cent increase.

Privatization is not on the table, he said.

“We were asked not to recommend privatizing health care,” Drummond said, adding that did not mean further involving the private sector.

To avoid short-term pain caused by quickly made policy decisions, Drummond feels the 20-year prescription needs to be followed.

The commission also calls for “aggressive” upcoming contract negotiations with the Ontario Medical Association, the body representing 25,000 doctors. Already, the Liberals have said they expect the doctors to settle for a 0 per cent increase. However, the OMA has not signalled it would accept zero.

“The health-care system is not really a system,” the commission writes. “What we have is a series of disjointed services in many silos.”

The recommendations include:

LHINS:

LHINS need to be beefed up with more funding and responsibility — not torn down as the Progressive Conservatives wish.

In theory, LHINs were created to allocate budges but in reality they do not do this and that must change, said Drummond. To do that, the 2,500 funded health agencies need to be streamlined into the networks. That includes hospital restructuring, which began in the mid-1990s, and reducing the all-powerful hospital boards.

The only exception to the regional rules should go to facilities serving everyone in the province such as the Hospital for Sick Children, Princess Margaret Hospital and the Centre for Addiction and Mental Health.

DOCTORS:

Ontario’s doctors are the best paid in the country so in the upcoming negotiations it is “reasonable” to set a goal of allowing no increase in compensation, the commission noted.

But decisions regarding medical procedures covered under OHIP are part of the compensation package negotiated by the government and the OMA and that shouldn’t be, said Drummond.

“Doctors should be consulted, but no more,” the report said.

DRUGS:

To handle skyrocketing drug costs Drummond has a number of ideas.

The Ontario Drug Benefit program, which covers almost all of the cost of prescription drugs for seniors and those on Ontario Works, should be linked more directly to income. This would allow for the “welfare wall” to be dismantled somewhat by covering the working poor.

A greater role should be given to the non-profit think-tank the Institute for Clinical Evaluative Sciences and Health Quality Ontario to conduct drug comparison tests so the province knows which medicine offers the best value and effect.

In order to drive drug costs down, Ontario should pursue with other provinces the possibility of setting a common price for pharmaceuticals.

COMPENSATION:

The pay for health and hospital CEOs and senior executives should be targeted to health outcomes and not the number of interventions performed.

High-level salaries should be reported publicly on a website.

PUBLIC HEALTH:

The 36 public health agencies should be folded into the LHINs. Public health should also be the sole responsibility of the provincial government. The current requirement that 25 per cent of the agencies receive funding from cities should be reviewed.

More money should be put in preventative health measures.

Drummond points out only 25 per cent of the population’s health outcomes are attributed to the health system. Yet only three-quarters of environmental factors that account for health outcomes such as education and income barely register in the health-care debate.

MENTAL HEALTH:

For too long, mental health and addiction costs have drained the system without being adequately addressed. Mental health costs are estimated at $39 billion annually and the ripple effects are felt in the justice, education and social services sectors.

Care is currently delivered through 10 ministries, 440 children’s agencies, 330 community mental health agencies and 150 substance abuse centres, the commission noted. There isn’t one body to coordinate care and that has to change, Drummond said.